Large Lamellar Corneoscleral Grafts: Tectonic Role in Initial Management of Severe Ocular Chemical Injuries

Purpose To report the outcome of large tectonic lamellar grafts in cases of severe chemical injury associated with corneal melt/perforation and scleral ischemia, with or without retinal detachment. Methods This was a retrospective interventional analysis of 7 eyes of 6 patients within 3 months of injury with simultaneous/subsequent surgical procedures to salvage globe integrity. Results Of 7 included eyes, both eyes of one patient underwent phthisical changes. In one eye, the retinal detachment was inoperable; in another, the retina was reattached with silicone oil tamponade, and underwent subsequent Boston type 1 keratoprosthesis with a final best-corrected visual acuity of 20/80 at 3-year follow-up. One eye underwent Lucia type 2 keratoprosthesis, one eye the modified osteo-odonto keratoprosthesis procedure, with visual recovery of 20/120 and 20/80, respectively, and one maintained vision of 20/200 for 2 years following a penetrating keratoplasty. The final best-corrected visual acuity was better than 20/200 in 4 out of these 7 eyes (57.14%). Conclusions In acute severe chemical injuries, corneal perforation with scleral ischemia can threaten globe integrity as well as preclude routine tectonic penetrating procedure. Presence of a concurrent retinal detachment in this setting further complicates the approach as well as the outcome. The use of a large tectonic corneoscleral lamellar graft provides a viable option in the achievement of tectonic stability in these eyes, facilitating future visual rehabilitative procedures.